SUPPLEMENTAL WAIVER FOR
INDEPENDENT INTERNATIONAL TRAVEL
Name of Student: ___________________________________________________________ID#___________________________________
Date of Birth: ____________________________________________________________________________________________________
Int’l Travel Opportunity: __________________________________________________________________________________________
Faculty Leader: __________________________________________________________________________________________________
In addition to the parameters outlined in Messiah College’s Study Abroad Contract (for academic opportunities) or
Assumption of Risk and Liability Release (for non-academic opportunities), which I have signed and affirm, I also agree
to this Supplemental Waiver for Independent International Travel due to my desire to travel independently after the
conclusion of the above International Travel opportunity (herein after “the Course”). My independent travel will begin
on:
_________________________________ (please specify time and date)
I acknowledge that I will be fully and personally responsible for any issues that may arise from the independent travel I
pursue, including any costs incurred from such independent travel and/or independent travel disruptions, and any
emergencies that may arise in the course of my independent travel.
I agree, on behalf of my family, heirs, and personal representatives, to assume all the risks and responsibilities involved in
my independent travel after the Course. I hold Messiah College harmless from any claims that may result from my
independent travel. Further, I release and agree to indemnify Messiah College, its officers, employees and agents, from
and against any present or future claim, loss or liability for injury to person or property which I may suffer, or for which I
may be liable to any other person, as a result of my independent travel and/or related to my independent travel.
I have read this Supplemental Waiver for Independent Travel carefully before signing it, and agree that it contains
my agreement with Messiah College as to my participation in the above-named international travel opportunity.
This agreement shall become effective only upon acceptance by the College of my application for the opportunity, and
shall be governed by the laws of the Commonwealth of Pennsylvania.
_____________________________________
Student Signature
______________________
Date
_____________________________________
Printed Name of Student
Parent or legal guardian must sign this waiver if student is under 18:
I am the parent or legal guardian of the Student, have read the foregoing Supplemental Waiver for Independent
International Travel, am and will be legally responsible for the obligations and acts of the Student, and agree for myself
and the Student to be bound by the terms of this Waiver.
_____________________________________
Signature of Parent/Legal Guardian or Next of Kin
______________________
Date
_____________________________________
Printed Name of Parent/Legal Guardian or Next of Kin
_____________________
Relationship to Student